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home - Oesophagus - Benign Oesophageal Lesions - Benign Flat Lesions Written by Dr Sebastian Zeki

Benign Flat Lesions

Written by Dr Sebastian Zeki Histology:Multifocal plaques of hyperplastic squamous epithelium with abundant intracellular glycogen.Lugol's solution, which turns plaques dark brown, so distinguishing from leukoplakia, monoliasis, and bullous pemphigoid, all of which can have a similar endoscopic appearance. Complications of inlet patches:Perforation and a tracheoesophageal fistula occurring at the site of an inlet patch.Dysphagia commonly from strictures, rings, and webs associated with the patch.Can get H. pylori in 75% who have H. pylori in the stomach.20 % also have Barrett’s. Endoscopic Features Of Inlet PatchesThe patches range in size from 2 mm to 4.5 cm and can be solitary or multiple.They are usually red, velvety and flat. Histological Feature of Inlet Patches:Corpus or fundic-type gastric mucosa, sometimes with parietal cells capable of secreting acid.Also have an associated inflammatory infiltrate. PathogenesisEmbryonic (not heterotopic) gastric mucosa with glucagon reactive cells only seen in embryonic formBUT...More closely resemble Barrett's mucosa rather than normal gastric mucosa, making a congenital origin seem less likely. Histological Features of Parakeratosis: Epithelial acanthosis.Basal hyperplasia.Dense, compact layer of parakeratosis, featuring cytoplasmic eosinophilia and pycnotic nuclei, covered by an outer layer of nonnucleated squamous cells. Associations of parakeratosis:Head and neck cancers.Submucosal fibrosis of the oral cavity, esp smokers and betel nut chewers. Parakeratosis Glycogen acanthosisIt is more common in males than females.It occurs in 40s and 50s.It occurs in 10% of all upper endoscopies.Endoscopic features typically involve multiple, uniformly sized round elevations in otherwise normal-appearing mucosa, Lesions are usually in the midportion of the oesophagus. Lesions can be up to 1cm.Associations include Cowden's disease and coeliac.Patients are usually asymptomatic. Flat Oesophageal Lesions Heterotopic sebaceous glandsMay represent reactive metaplasia of ectopic, pluripotent salivary type mucous glands in the oesophagus that were initially displaced during embryonic development.Endoscopy shows yellowish gray, plaque-like lesions that resemble xanthelasmas.Lesions frequently occur in clusters, with several cases of up to 100 reported in the literature.Histological features include lobules of cells with sebaceous differentiation within the lamina propria.The lesions have no known malignant potential. Inlet patch It is defined as a heterotopic gastric mucosa of the upper oesophagus.It is found in the proximal 3cm oesophagus.The population prevalence is 5%.It is often seen in children and prevalence doesnt increase with age.It is usually asymptomatic.No treatment is necessary, occasionally PPI can be useful. Endoscopic features of parakeratosis:Endoscopy shows whitish, membranous linear plaques.

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